Tuesday, April 24, 2012

Republicans are absolutely gleeful about the possibility that the Supreme Court may strike down the Affordable Care Act, despite the fact that doing so would increase premiums, cause millions to lose health insurance, and ultimately raise health care spending.

Now, several health experts are warning of another unintended consequence: Medicare might not be able to function properly, potentially putting patient care and payments to doctors at risk. As some experts told NPR, the program could be thrown intocomplete chaos:

“The Affordable Care Act has become part and parcel of the Medicare system, encouraging providers to deliver better, more integrated, better coordinated care, at lower cost,” says Judy Feder, a public policy professor at Georgetown University and former Clinton administration health official. “To all of a sudden eliminate that would be highly disruptive.”

Sara Rosenbaum, a professor of health law and policy at George Washington University, puts it a bit more bluntly: “We could find ourselves at kind of a grand stopping point for the entire health care system.”

And it’s not just Democrats warning of potential problems. Gail Wilensky, who ran Medicare and Medicaid under President George H.W. Bush, says she doesn’t think it’s likely that the court will strike down the entire health law. But if it does, she says, “it seems like it takes everything with it, including those aspects that are only very peripherally related to the expansion of coverage.”

As Rosenbaum noted, if the law is ruled unconstitutional, “Hospitals might not get paid. Nursing homes might not get paid. Doctors might not get paid. Changes in coverage that have begun to take effect for the elderly, closing the doughnut hole might not happen. We don’t know.”

This uncertainty is already spilling over into the market: the ratings service Moody’s reported earlier this month that for-profit hospitals could be hit particularly hard if the law is overturned. As the report said, “Uninsured patients enter the health care system through the emergency room and often wind up admitted and accumulating bills they don’t have the means to pay. The continued rise in uncompensated care costs would limit operators’ revenue growth and profit margins and constrain cash flow.”